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Bill

HB 11

Health Insurance - Access to Nonparticipating Providers - Referrals, Additional Assistance, and Coverage

2025 Regular Session Introduced by Tiffany Alston and 22 co-sponsors

Maryland requires health insurers to provide expanded access and financial assistance for nonparticipating provider referrals and coverage.

Approved by the Governor - Chapter 660
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Bill Summary · HB 11

Legislative bill overview

HB 11 requires health insurance plans in Maryland to provide patients with additional assistance and coverage options when accessing nonparticipating (out-of-network) healthcare providers. The bill establishes new referral procedures and transparency requirements for insurers when patients are referred to or choose to use providers outside their insurance network.

Why is this important

Many patients face significant out-of-pocket costs when seeing out-of-network providers, even when in-network options are limited or unavailable. This bill aims to reduce financial barriers and improve access to necessary care by requiring insurers to better facilitate and cover out-of-network referrals, potentially lowering surprise medical bills and expanding patient choice.

Potential points of contention

  • Insurance company costs: Expanded out-of-network coverage could increase insurer expenses, potentially leading to higher premiums for all policyholders
  • Definition ambiguity: The bill's specifics on what constitutes "additional assistance" and when coverage applies to nonparticipating providers may create disputes about eligibility and payment obligations
  • Network adequacy trade-offs: While improving out-of-network access, the bill may reduce incentives for insurers to build robust in-network provider networks in underserved areas

Compiled from official sources — confirm details with the bill’s official record.

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